The First Visit

New Patient Evaluation

Chronic pain management begins with a new patient evaluation. This assessment allows the doctor to characterize the pain, clarify its impact, and evaluate any other medical and psychosocial problems. The assessment determines whether additional evaluation or testing is needed to diagnose and understand thepain. The doctor will be reluctant to treat a chronic pain problem unless he feels comfortable that a diagnosis has been made that adequately explains the chronic pain.

The doctor will ask about the duration and location of the chronic pain, its severity and quality, and factors that make the chronic pain better or worse. The doctor may also inquire as to changes that have occurred in the person's life as a result of the pain. The doctor will also want to know about the nature of the patient's other medical and psychiatric problems. This assessment requires a physical examination and a review of previous medical records.

As part of the new patient evaluation, it is important that all prior efforts at pain treatment be discussed. The doctor will ask about medicines and other conventional treatments like physical therapy or chiropractic that have been tried in the past. The doctor will also want to know about other alternative treatments that the patient may have tried including acupuncture, massage, yoga, herbal and nutritional supplements, or others. The doctor will also be interested in any interventional pain management techniques that the patient may have already pursued. The doctor may ask the patient to sign a release of information to allow him to gather prior treatment records and testing results. Providing this information will help Dr. Wolfe understand the nature of the pain and formulate a treatment plan.

New Patient Questionnaire

In an effort to maximize the information that Dr. Wolfe can obtain, review and discuss during the new patient evaluation, each patient will be asked to bring a completed new patient questionnaire to the first visit. The new patient questionnaire allows the doctor to review the information the patient has provided and then ask additional focused questions regarding the patient's condition rather than spending the visit gathering medical history and other basic facts.

What to Bring

Other than the new patient questionnaire, each patient should bring identification and insurance cards. If the patient does not know if they should bring something along, the patient should bring it anyhow and let the doctor decide if he wants to review it or keep a copy.

Any old medical records and any x-rays, MRIs or images of other testing should also be brought along.

What To Expect

Each new patient evaluation will include a review of information and the asking of a number of focused questions. Though some patients find it odd, the doctor may ask each new patient to remove a portion of their clothing (undergarments are kept on), put on an examination gown and undergo a physical examination sufficient for the doctor to assess the chronic pain condition and gather additional findings. At the minimum, soft tissue, joints, sensation, strength and reflexes may be tested. This will involve some poking and prodding and is not meant to cause more pain but rather to allow the doctor to develop a hands on understanding of the chronic pain condition.

By the end of the visit, Dr. Wolfe will either make a diagnosis or organize additional testing to help to make or confirm a diagnosis. For patient who are here for a consult only or second opinion, this will complete the visit. For patients who are here for evaluation and treatment, Dr. Wolfe may well start or order some form of treatment at the first visit.

What Not To Expect

On occasion, a new patient evaluation arrives with no prior treatment or records. In these cases Dr. Wolfe will spend a reasonable amount of time assessing the patient. He may or may not make a diagnosis at the first visit and may ask the patient to return for additional assessment. If no diagnosis is made, it is unlikely that any treatment will be started.

Sometimes a new patient comes with the expectation that the new patient will be getting his pain medications, usually narcotic pain medications, from Dr. Wolfe at their first visit. Unless specific arrangements were made with the referring doctor ahead of time and also prior prescription records have been forwarded to the office for review, it is unlikely that Dr. Wolfe will simply take over the prescribing of narcotics from the referring physician, especially at the first patient visit. In general, the doctor does not offer a narcotic-prescribing service.

There are times when a new patient has trouble finding the office or for some other reason is substantially late for the appointment. If Dr. Wolfe can accommodate the late arrival, an effort will be made to fit the new patient into the schedule. In some cases where the schedule is full and all other patients are on time and present, the doctor will ask the new patient to reschedule rather than inconvenience other patients.